Relevance of an undergraduate occupational therapy education program: a critical participatory action research studyAbstract
Introduction Today’s fast-paced life puts health-promoting professions in a challenging position, especially in view of a broader definition of health. In Georgia, where the occupational therapy profession is still developing, aligning education with local societal needs is crucial for its growth and impact. Scholars have tried to define the developing role of occupational therapy, yet little research examines how professional education prepares therapists for the emerging challenges of the context. Acknowledging the impact of various factors in education helps the profession become more accommodating to the local context.
Objective How does the occupational therapy education program prepare professionals for community needs in the context of Georgian society?
Methods The local professional occupational therapy program was reviewed through critical participatory action research using a constructivism lens. Action and data collection methods used with different community members were: photovoice, semi-structured interviews, and World Café.
Results Three main themes and four categories emerged from collected data: 1. Learning by doing – ready for the pediatric field: a) Learning by doing – ready for the real world b) Preparing pediatric occupational therapy practitioners 2. Making learning attainable to students and supported by teachers: a) Lack of accessible literature b) Support on and off the field 3. Belonging to a supportive professional community.
Conclusion The CPAR process led to creating shared knowledge that can be a stepping stone toward contextually relevant occupational therapy curricula and practice. These findings contribute to the ongoing development of the occupational therapy education in diverse contexts ensuring that programs are responsive to the needs of learners and professional practice.
Keywords:
Action Research; Occupational Therapy; Education
Resumo
Introdução O ritmo acelerado da vida de hoje coloca as profissões de promoção de saúde em uma posição desafiadora, especialmente à luz de uma definição mais ampla de saúde. Investigadores tentaram definir o papel e o constante desenvolvimento da profissão de terapia ocupacional. Na Geórgia, onde a profissão de terapia ocupacional ainda está em desenvolvimento, alinhar a educação às necessidades da sociedade local é crucial para seu crescimento e impacto. Estudiosos tentaram definir o papel em desenvolvimento da terapia ocupacional, mas há poucas pesquisas que examinam como a formação profissional prepara profissionais para os desafios emergentes do seu contexto. Reconhecer o impacto de vários fatores na educação ajuda a profissão a tornar-se mais adaptável ao contexto local.
Objectivo Como o programa de formação em terapia ocupacional prepara os profissionais para as necessidades da comunidade no contexto da sociedade georgiana?
Métodos O programa educacional local de terapia ocupacional foi analisado por meio de pesquisa-ação crítico-participativa, a partir de uma perspectiva construtivista. Os métodos de ação e coleta de dados utilizados com diferentes membros da comunidade de aprendizagem foram: fotovoice, entrevistas semiestruturadas e World Café.
Resultados Três temas principais e quatro categorias surgiram dos dados coletados: 1. Aprender fazendo – pronto para o campo pediátrico a) Aprender fazendo – pronto para o mundo real b) Preparando praticantes de terapia ocupacional pediátrica 2. Tornar o aprendizado acessível aos alunos e apoiado pelos professores a) Falta de literatura acessível b) Apoio no campo e fora dele 3. Pertencer a uma comunidade profissional solidária.
Conclusão O processo de pesquisa-ação participativa levou à criação de um conhecimento compartilhado, que pode ser um ponto de partida para currículos e práticas de terapia ocupacional mais contextualmente relevantes. Esses achados contribuem para o desenvolvimento contínuo da educação em terapia ocupacional em contextos diversos, garantindo que os programas sejam responsivos às necessidades dos aprendizes e da prática profissional.
Palavras-chave:
Pesquisa-ação; Terapia Ocupacional; Educação
Introduction
People today live a fast-paced life and are witnessing accelerated lifestyle changes that can cause evolutions in old issues and bring up new ones (Rosa, 2014). The new reality is posed as a challenge for health-promoting professions like occupational therapy, which has the competencies and knowledge to work with the client(s) to ensure their well-being, social inclusion, participation, and overall health through everyday occupations (World Federation of Occupational Therapy, 2012). The conceptualization of health has also evolved, embracing mental, physical, and social well-being that leads to a socially and economically productive life (World Health Organization, 2021). Wilcock (2007) also broadens the understanding of how addressing socio-historical and political contexts has become critical in expanding the role of occupational therapy. Occupational therapy and occupational science scholars have tried to define the role of the profession that tackles socio-historical and political contexts, among others, affecting people's opportunities for participation in valued activities. Specifically, occupation-based social transformation (Canadian Association of Occupational Therapy, 2020) has recently been used to strengthen such efforts. Rudman describes the occupational therapist’s role in social transformative work as a mediator between political decision-makers and disadvantaged groups of society. For Van Bruggen (2017), the focus of social transformative work is to facilitate bridging the gap that excludes vulnerable groups of people from society. In her work, capability-building for people suffering from occupational injustice is seen as one of the essential mediators for an inclusive society (Van Bruggen, 2017). Communities' active involvement makes social equity-driven goals more sustainable (United Nations, 2015). The same idea resonates in Pollard et al.'s (2008) definition of a political practice of occupational therapy (PPOT) to achieve occupational justice. It is sometimes disrupted by stigmatizing and oppressive conditions such as disability status, race, ethnicity, education level, income level, gender, sexual identity, environmental degradation, and war or conflicts (Sakellariou & Pollard, 2013). These factors go beyond individual disadvantages (Hammell, 2017), explaining that occupations people can or cannot do are caused not only by their personal choices but mostly by their surroundings and the context of those choices (Pollard et al., 2020). Context is a major determinant of people's participation level and plays a role in constraining their opportunities. Scholars have widely and critically discussed contextual factors and their influence on participation in occupations over the years (Agner, 2020; Canadian Association of Occupational Therapy, 2020; Hammell, 2017; Hammell & Iwama, 2012; Iwama, 2005; Rudman, 2018). Such critical thinking contributed to shifting the focus from individual to societal factors to better understand participation in occupation, and from the medical model to the social model in the profession, ultimately affecting occupational therapists' role in everyday practice (Hammell, 2020; Rudman, 2018).
Occupational therapy education worldwide has increasingly adopted localization strategies to drive occupation-based social transformation practices among students, graduates, and practitioners. Examining successful examples in south eastern Europe (Van Bruggen, 2011) and Latin America (Galheigo, 2021), where localization addressed contextual challenges, underscores the vital role of such strategies. Localization, involving practices arising from specific regions or countries, emphasizes recognizing community needs, leveraging local networking, adaptation, and development (Cheng, 2003, 2005).
Critically, these successful educational movements share a common thread—effective use of localization strategies that resonate with the context (Hermans & Dimaggio, 2007). In contrast, the goal of globalization, which aims to dissolve borders between countries and cultures, is met with criticism, particularly from a theoretical imperialism standpoint (Canadian Association of Occupational Therapy, 2020; Hammell, 2011; Mahoney & Kiraly-Alvarez, 2019; Think Business Events, 2018). Despite the inherent conflict between globalization and localization, their coexistence is essential for the sustainable development of a multicultural society (Chou & Ching, 2012).
The focus on localization in education is pivotal, evolving teaching methods to align more closely with the local context, benefiting students, teachers, future professionals, and the broader community. In Georgia, the occupations of its people are shaped by specific sociohistorical and political contexts such as poverty, unemployment, limited social services, high number of disadvantaged communities, internally displaced people because of wars and natural disasters, ongoing political conflicts (Chavchavadze, 1987; Gogebashvili, 2015; Institute for Development of Freedom of Information, 2015; Javakhishvili, 2021; Georgia, 2024; National Statistics Office of Georgia, 2022; Vachnadze & Guruli, 2014). All these emphasize the necessity of tailoring educational approaches to these nuanced factors.
Georgia’s specific contextual challenges: occupational therapy higher education addressing occupational justice
Occupational therapy in Georgia was introduced by the European Network of Occupational Therapy in Higher Education (ENOTHE) as a profession that challenges social disparities and contributes to promoting inclusion in society using occupations (Van Bruggen, 2011). The profession was officially established in the country through higher education with the first and only Occupational Therapy bachelor's program (which the lead researcher of this study completed) at Ivane Javakhishvili Tbilisi State University (World Federation of Occupational Therapy, 2021). The occupational therapy program was designed with a foundation rooted in the principles of inclusion, occupational justice, and social justice. This intentional approach aimed to empower occupational therapists with the skills and perspectives necessary to address contemporary challenges in Georgia. These challenges were closely intertwined with dynamic political processes and shifts associated with a change in government. The appointment of a new Western-driven government in the early 2000s signaled a departure from the post-Soviet governance model, with a clear motivation to implement more democratic and inclusive governance practices in the country (Fairbanks Junior, 2004; Jawad, 2005).
Similarly, local contexts have impacted the profession's development throughout the years in different parts of the world (Pollard et al., 2020) and the establishment and evolution of the profession took a different paths in different local contexts. For instance, early work of occupational therapists in Brazil, were more politically driven against institutionalization and social injustice and fought for the right to equal opportunities and healthcare (Galheigo, 2021). Similarly, the development of occupational therapy in post-Soviet Union countries (Pollard et al., 2020), including Georgia, was also driven by and for social changes.
Despite the initial intention of the occupational therapy education in Georgia of transforming social challenges, most out of the sixty-one occupational therapists in Georgia (1 therapist for every 80.000 citizens) are employed in children's rehabilitation and early development programs (National Statistics Office of Georgia, 2022). Services in these rehabilitation settings are usually impairment focused (Georgian Government, 2018). It appears to be a complex situation where the social challenges targeted by the occupational therapy curriculum persist however professionals operate in a field that appears to be disconnected from broader social and contextual challenges.
Given that the occupational therapy profession is still developing, ensuring that educational programs align with local societal needs is essential for its growth and impact. Across the world, occupational therapy education has progressively integrated localization strategies to enhance relevance and effectiveness, but their importance is even more pronounced in contexts where the profession is newly emerging. The adaptation of educational approaches to local realities plays a crucial role in ensuring that future professionals can effectively address both existing and evolving challenges within their communities. The recognition of this ongoing challenge inspired the initiation of this study.
Objective
Therefore, this study aimed to better understand how the current occupational therapy education program prepare professionals for local community needs in the context of Georgian society.
Methods
A Critical Participatory Action Research (CPAR) with Students, Graduates, and Educators of the Program was conducted in Georgia in 2022. CPAR is grounded in critical constructivism and social epistemology, facilitates the creation of new knowledge through open dialogue and heightened critical awareness (Kincheloe, 2008), fostering both personal and social consciousness for constructive actions.
In education, critical constructivism emphasizes collaborative knowledge construction among teachers and students across diverse contexts. Rejecting the idea of knowledge transmission, it sees knowledge as temporary and context-specific, encouraging a nuanced understanding of the social, political, cultural, and economic dimensions (Kincheloe, 2008). A primary goal is to generate democratic knowledge by exploring perspectives often overlooked by mainstream cultures.
CPAR method addresses and investigates a posed query in a critical and collaborative way between co-researchers that are directly affected and interested in the topic (Kemmis et al., 2014). In a CPAR community members have essential and valid understandings and experiences of an issue, which are necessary to bring about meaningful social change at the local level (Cockburn & Trentham, 2002). This assumption is democratic, and close to the role of occupational therapy working towards social transformation (Townsend & Wilcock, 2004).
Thus, the CPAR process emphasizes critical self-reflection regarding challenges, which resonates with a commonly used approach in the development of the occupational therapy profession: interrogating own practices (Lopes, 2021). Therefore, CPAR for the local occupational therapy community of practice can foster the recognition and resolution of prominent challenges in occupational therapy education, which manifest as obstacles in addressing local social issues. This requires collaborative initiatives involving educators and students within the education program.
Research Context and CPAR Team
The fieldwork was conducted by the lead researcher (first author) and the local research core team (LRCT). The lead researcher is an occupational therapist, trained in Georgia, who was triggered by the tension between the focus of occupation justice-driven occupational therapy work and the actual work of occupational therapists in Georgia, predominantly in rehabilitation services.
The LRCT included four people: two currently teaching in the program, one former teacher, and a third-year student. Table 1 displays key information to situate the LRCT.
Each member of the LRCT took on specific yet flexible roles throughout the CPAR process. The lead researcher, also acting as the project coordinator, facilitated meetings, documented progress, and led data analysis. Co-researchers contributed to research design, participant recruitment, data collection, and analysis. The two educators offered critical input during methodological decisions and led interview sessions. The former educator served as a liaison with community stakeholders and members (present educators, students and practitioners), while the student member brought a valuable peer perspective during analysis discussions. All members actively engaged in reflective dialogue and decision-making, in line with CPAR’s principle of shared ownership.
The online announcement inviting interested potential members of LRCT was initially shared with the Georgian occupation therapy association group. The lead researcher approached two teachers based on their prior interest in the subject and their role in the education program. Eligibility criteria for co-researchers were a) a present or past connection to the academic community, b) shared interest in the topic, and finally, c) their ability to contribute time to the research. The latter was essential to include because of the existing often-voiced challenge of limited availability due to their multiple professional responsibilities.
The LRCT and the lead researcher had seventeen meetings from 12/25/2021 to 06/02/2022. The process closely followed critical participatory research group protocol (Coghlan & Brydon-Miller, 2014; Kemmis et al., 2014). The lead researcher facilitated open communication by spending some time after each meeting to reflect on the process and review the expectations and responsibilities of each team member. Basic working rules (Kemmis et al., 2014) for the LRCT were also set. They were presented by the lead researcher to the LRCT at the beginning of the research process and reiterated during meetings. Most of the time, the LRCT and lead researcher agreed on the action plan, and voluntary consensus actively occurred. The work was divided relatively evenly. Each session was closed with a to-do list of actions, giving the LRCT members time to mark the task they would like to take on for the next meeting. The remaining tasks were then assigned by the lead researcher, who would also send out the day's report to help the group keep track of the progress. The consistency of the meetings, maintaining a solid work ethic, and being aware and reminded of the responsibilities resulted in building relationships and eventually forming a group willing to continue collaborating under the name For Georgian Occupational Therapy Education (GEOTEDU).
The fieldwork team went through three cycles (Figure 1). The main action of each cycle was data collection: photovoice (Wang & Burris, 1997) with students, interviews (Brinkmann & Kvale, 2018) with practitioners and finally, world café (Community Toolbox, 2022) with teachers. During each cycle, LRCT and lead researcher would first collect data, transcribe it, and then analyze it as a group by reflecting on possible general themes. The lead researcher then reviewed preliminary results, conducted individual thematic analysis, and results were again shared with the rest of the team. After each cycle, the team would reflect on the emerging themes and plan further action of the cycle according to preliminary results from the previous data. The process was organized as a constantly moving cycle with an emerging design (see Figure 1).
Recruitment
Participants (Table 2) were identified through purposive sampling. Everyone in each sample group who met the criteria was invited to participate.
An email with a description of the photovoice, questions, and overall goal of the activity was sent to potential student participants. They were requested to send photos and narratives back to the designated email address. Inclusion criteria were: having active student status and being enrolled in the occupational therapy program.
Practitioners were recruited through an email explaining the aims of the study and the interview's overall goal. The eligibility criteria for practitioners were to have graduated from the mentioned program within five years.
Educators currently involved in academia were invited via Facebook event invitation to join the World Café meeting with a detailed description of the meeting's aim and a list of discussion topics.
Informed consent was taken from all participants, emphasising that participating was not compulsory and their decision whether or not to participate would not have any consequences for their studies or work.
Data collection
To better understand how the education program prepares professionals for local community needs, data was gathered from different members of the education program community during the various cycles of the CPAR.
Photovoice activity with students was the first step after establishing the LRCT. The method was chosen to help include different year students and facilitate them to express their opinions creatively and actively (see Appendix A). The photovoice's goal was to understand students' perceptions of and attitudes toward the curriculum and the overall education process.
The LRCT together with the lead researcher developed the interview guide (see Appendix B), based on Kallio et al. (2016). The goal was to see the practitioners’ perception of the program's effect on their current practice and their general appraisal of the program in retrospect. The following steps were followed: a) evaluating the appropriateness of the semi-structured interview with practitioners; b) utilizing previous knowledge (literature review done by the lead researcher and photovoice data collected in previews cycle); c) formulating preliminary interview guide by coming up with probable questions and connecting the research goal and central question to them; d) testing and e) presenting final guide.
The first researcher and three members of LRCT conducted and transcribed two interviews each that lasted from thirty minutes to one hour.
World Café was an interactive meeting with current teachers of the occupational therapy education program. The World Café "table" themes were chosen from the previously collected data topics. The method was chosen to create a more welcoming environment for educators to share their views and challenges of the teaching process and give them a chance to exchange teaching experiences with each other. The meeting was participant-led with the goal of reflecting on their roles and enriching critical awareness on the subject. World Café represented the study's closing cycle.
All interactive meetings, as well as interviews, were conducted online via password-protected Zoom meetings. During group meetings, ideas were shared and recorded using collaborative Google Docs and Slides, which all members had access to. Each group designated one member per meeting to organize the collected ideas and suggestions and share the summary with the rest of the group.
Data analysis
After each action, the reflection and analysis were done, at the meetings with the lead researcher and local core research team to plan further steps. The lead researcher conducted a further thorough qualitative analysis.
In order to make the analysis transparent, a codebook and a map of the analytical process for each data set were created (see Appendix C) (Anfara Junior et al., 2002).
Data from different stages and sources were analyzed separately and later integrated into themes.
The photovoice analysis strategy was informed by Tsang’s (2020) work. It consisted of four stages of photo material analysis: a) photograph analysis based on the researcher's interpretations, b) photograph analysis based on participants' interpretations (narratives), c) cross-comparison, and d) theorization (merging into final categories and themes).
From photovoice, fifty-five out of seventy-eight photos with their narratives were included in the analysis process. Photos that did not answer the questions asked and were beyond the aim of the study (for example, the world pandemic's effect on their studying process) were excluded.
All Local Research Core Team members had access to the data. Final categories and themes were presented, communicated, and agreed on between team members.
Qualitative data from practitioner interviews as well as photovoice data was coded and later merged using Applied Thematic Analysis (ATA) (Guest et al., 2012). ATA comprises several different theoretical and methodological perspectives and synthesizes into one methodological framework, which is rigorous and yet inductive. Compared to thematic analysis, ATA is more transparent and rigorous by using more comprehensive and clear procedures designed to identify themes in a transparent and credible way.
To clarify the applied thematic analysis (ATA) procedures, we followed a systematic, multi-step approach in which data was first segmented and coded based on emerging themes. Each segment was identified by its relevance to the research questions, and codes were refined iteratively as new insights emerged. The process began with an initial exploratory reading of the interview and photovoice data, followed by the development of a codebook that categorized and defined the key themes. These themes were then organized and examined through a detailed review of the data to identify patterns and relationships. Throughout, we ensured transparency and consistency by using clear criteria for segment boundaries, code definitions, and thematic analysis, enabling a rigorous and credible interpretation of the data.
Ethical consideration
Ethical clearance was not obtained for this study because Georgia has no national ethics board. However, the researcher included ethical considerations throughout the research planning and implementation process, such as developing and sharing the consent form with study participants, actively ensuring their anonymity, and securely saving obtained data.
This CPAR was carried out within the scope of the lead researcher’s thesis research as part of the European MSc in Occupational Therapy. The second and third co-authors provided supervision in the process. This project was informed by the lead researcher’s prior experiences as a bachelor's student in an educational program in Georgia and now as an occupational therapy educator in the same program. The lead researcher facilitated all meetings with the local research core team in their local language, Georgian, also her native language. Because the lead researcher had the same ethnic background and was familiar with the language and context, she had to constantly navigate her role as both an insider and outsider, holding different life experiences such as having limited fieldwork experience in the local context and currently living outside of Georgia.
Results
Photovoice with students
Students from all year groups (forty-five in total) were invited to participate in the photovoice project. Local research core team members gave instructions to each year group during their online class and in written form. Additionally, all participants were invited to a photovoice meeting/discussion, a participant-led analysis where members could critically reflect on their experiences as students (Tsang, 2020).
One of the most prominent themes from photovoice data was making learning attainable. Students described challenges with engaging in literature-based work, including translation, analysis, and application to assignments or practice. They noted that the effort and time invested in these tasks often felt wasted. They mentioned spending twice as much time on English literature as on Georgian sources. Additionally, students expressed that the lack of Georgian examples of practice and research made it harder to relate theory to practical application. They also reported that processing literature in English took significant time and contributed to difficulties in understanding core occupational therapy concepts and professional terminology. Fifteen students identified the category of making sense of existing literature as a key aspect that made learning challenging. Another category within the same theme, which students described as frustrating, was related to organizational stressors.
We often don’t know when the exam will be, what type of exam we will have, and find out late in the semester, which is stressful. It often happens on holiday time or right before holidays, which takes opportunity from us to rest and relax (Student #4).
Students described these organizational challenges as limiting their professional development. They also perceived them as reflecting teachers’ attitudes toward the program, the learning process, and the extent to which academic engagement was prioritized.
Another prominent theme was being part of a supportive community. Students described experiencing connectedness and close relationships as a key characteristic of the program that positively influenced their learning. They reported feeling hopeful and expecting support from the broader learning community. In addition to teachers and students, the participants mentioned the whole occupational therapy community, including practitioners currently not directly involved in the program.
I have an opportunity to know almost every member of the community, students, teachers and practitioners. It seems we are all connected and in contact… (Student #11).
The final significant theme is Learning by doing – ready for the real world. Several students described the program’s characteristics as unique and supportive of their learning process. They referred to both their current experiences and future expectations when discussing the impact of the program. After successfully completing the second-year module, students have the opportunity to work under supervision. They described gaining first-hand experience with practical learning and skills that they identified as useful in their current practice. Students also noted this as a distinguishing feature of the program, particularly when comparing the intensity of practical assignments and fieldwork exposure to other health professions' curricula. Additionally, they described gaining nonacademic skills such as arts and crafts, woodwork, and building adaptive devices by hand – all of which they associated with feeling prepared to work more independently.
I like that we do a lot of work with our hands, creating tools with our hands, being physically involved in the process, making adaptations (Student #7).
Interview with practitioners
The first theme from the interview data was the Lack of accessible and relevant literature. Similar concern regarding nonexistent Georgian literature, challenges of translating English texts and making sense of the professional terminology was highlighted by students in photovoice. Practitioners added the dimension of cultural inadequacy or sometimes inapplicability to the local context and practice. Respondent #1 calls some of the provided techniques "not fitting in Georgian reality" and explains:
Theory and fieldwork do not always align because the techniques the theory tells you to use are sometimes unattainable for our reality. The reason can be a lack of skills we are taught, societal awareness, lack of finances, limited rehabilitation programs in Georgia... Often there are no appropriate resources to implement techniques suggested in the literature in fieldwork.
Another major theme was Preparing pediatric OT practitioners. This theme was formed by merging two categories, as both addressed similar aspects of the participants' experiences. Practitioners praised the fieldwork assignments integrated throughout the program, which they described as distinguishing this program from other health professional education programs. They highlighted the value of practical assignments and the opportunity to engage in fieldwork starting in the second year, describing these elements as the program’s main contribution to their professional development. Practitioners also compared the program favorably to other educational paths, emphasizing that it provided them with early and direct entry into their professional field. Respondent #2 shows an example:
I have been working as an occupational therapist from 2nd year, versus my friends for example who studied on different programs and none of them use that knowledge or diploma now, they all work in different places.
They feel confident in the practical skills in the pediatric field gained within the program and are currently using them in their day-to-day practice. All respondents currently work in rehabilitation and early development programs for children. They highlighted the supportive supervision in the pediatric area, the organized fieldwork plan, and the opportunity to apply theory in practice as central elements of their learning experience. These aspects were consistently described across interviews and photovoice discussions with students, which led to combining related categories under the theme of preparing pediatric OT practitioners, reflecting the emphasis on this field within the program.
The last theme was Support on and off the field. We unified classroom (off), and fieldwork (on) support under the same theme. As mentioned in the photovoice discussions with students, they expressed frustration related to organization challenges, such as moving assignments and exam deadlines, and poor communication between students and teachers regarding scoring and feedback in earlier years. On the field, need of support was added by practitioners and specifically addressed the issue of finding the practical cases/clients (individuals, groups, organizations) that often was the student's responsibility to fulfill their requirements.
It [Looking for possible clients] adds to the overall stress. So, it is more like training about how to find these clients or organizations and to work in these extreme situations rather than training in basic OT skills and techniques (Respondent #5).
As shown in Figure 2 the final three themes from photovoice and interview data were merged:
Students and practitioners, while mentioning preparedness for the "real world and practice," are talking about one specific field they have working experience in. Therefore, it would be only suitable to merge the theme of preparing pediatric OT practitioners with learning by doing – ready for the real world. In reality, graduates are preparing for the actual practice, which is expected to be the pediatric field, because of the program's inadvertent focus and the current industry demand.
Lack of accessible and applicable literature was already included in the photovoice theme: making learning attainable. Therefore, it was naturally merged. Support on and off the field was added as another dimension for the learning process in the program perceived by current and former students. A new united theme making learning attainable [to students] and supported [by teachers] was created. The theme represents students' wishes and the need for a more accessible, attainable, and supportive learning process. It is the most prominent theme with sub-themes.
Discussion
The study aimed to investigate how the occupational therapy education program equips professionals to meet the specific needs of the local community within the framework of Georgian society, as perceived by educators, former and current students.
The following section will discuss each emerging theme in connection with examples and approaches from different contexts.
The results demonstrated the importance/meaning of gathering context specific data and planning the actions locally to address relevant issues that were raised.
Learning by doing – ready for the pediatric field
Students and practitioners see the professional program as a tool that allows them to learn by doing precisely what the local employers within the healthcare sector are expecting from future occupational therapists. Moreover, professionals are primarily working in pediatric rehabilitation programs. Students need the education to use knowledge to survive and thrive in their local context and offer their expertise and intellectual and practical resources to the global society (Altbach, 2004). Such a goal can only be achieved if there is a connection between academic and industry requirements (Chou & Ching, 2012). Participants have a strong feeling of connectedness, which comes from their first-hand experience – a hundred percent of employment rate for graduates of the program. However, this leads to the disproportionate development of other practice fields and can be seen as wasted human and time resources on other modules in the curricula that are less likely to be used in practice.
A study done by Crowe & Mackenzie (2002) findings suggests that students are more likely to work in a clinical area in which they have had the most fieldwork and less likely in areas where the fieldwork was limited or absent.
In Georgia’s case, the organized pediatric placement, supportive supervision, and experienced teachers in the field who can model and give thorough feedback create a positive fieldwork experience that leads students to choose work in the same field as that is where they feel most knowledgeable and experienced.
Another future practice field determinant, according to Crowe & Mackenzie (2002), is the timing of the placement. Fieldwork experiences in the latter stages of an occupational therapy program are the most important. In their example, students will most likely choose the field they are working in during the last year of their studies. Their confidence and gained knowledge throughout the program influence their positive working experience and leads to eventual field choices. In Georgia’s case, although students' dominant fieldwork – pediatrics is in the program's second year, timing is still crucial: after the second-year, students are allowed to have paid jobs as OTs in the pediatric field under supervision.
Moreover, it appears that, eventually, the decision to pursue an area of occupational therapy practice is governed by pragmatic elements specific to each situation (Crowe & Mackenzie, 2002). There has been a climate of increasing occupational therapy workload in the pediatric field in Georgia. Acquired role of occupational therapists in the mentioned field is impairment focused with less attention to the participation and social inclusion focus that was intended from the start of OT (education) in Georgia. It is worthwhile to mention that society seemingly shifts back to clinical opportunities and the change is shaped by context and the history rather than being practitioners’ conscious choice. Students and practitioners are in high demand and are usually experiencing a higher than usual workload after graduation. Participants compare themselves to other health professional program graduates, who often have no such opportunity to work in their professional field. Socio-economic background and low employment rate also play a role in making pragmatic decisions when choosing the specialty for local occupational therapists.
Making learning attainable [to students] and supported [by teachers]
The challenge of applicability of the existing occupational therapy literature and the reality of dominance of theory written in the English language is not unique to Georgian occupational therapists. Localization of the theory and practice has been challenging and the goal some other countries' occupational therapy societies have been striving for. Comparably, one of the biggest challenges voiced by Brazilian occupational therapists that affected the development of the profession in the country was the challenge of relating local practice to existing theory and literature at that time (Galheigo, 2005, 2011, 2021). Having a distinct culture and different values and ways of living from the Western world contributed to the lack of theoretical background for local occupational therapists. Limited access to international literature and the applicability of studies to local practice were two of many challenges local professionals have faced. Translation costs were added to the disadvantages affecting students and practitioners. Exploring local practice context by occupational therapy teachers and practitioners helped with the publication of local journals and books.
Additionally, working in interdisciplinary teams other than medical disciplines enabled occupational therapists to broaden their theoretical frameworks outside the usual professional literature (Malfitano et al., 2014). The latter helped develop the local theory that was tailored to practice – one way of localizing education.
Being able to find disadvantaged clients/organizations can be seen as the basic skill for a more committed, socially responsive OT. Therefore such training promotes inclusion/participation-focused rather than impairment-focused OT approach. Although it has been perceived by both existing students and graduates, as the challenge rather than basic occupational therapy skill, it is an important implication for further exploring this part of the program and consciously making decisions to develop it further.
It is crucial for upcoming professionals to possess the skills necessary to actively contribute to the establishment of their own practices. In essence, providing students with the opportunity and freedom to identify, approach, and explore unconventional occupational therapy practice fields is a significant competence. This capability can benefit the potential development of future practices in the Georgian context.
Placement and fieldwork assignments are crucial ways to localize and ground the theory for the students. It helps students in professional development via attaining necessary skills. Supervision can contribute to a positive or negative fieldwork experience for learners. Fieldwork is often a determinant in professional career decisions. Eventually, a student will choose the area of practice based on where they feel more competent to work (Crowe & Mackenzie, 2002). Therefore, the support from the teachers and supervisors, together with organizational help, is crucial in the successful education process.
A study by Rodger et al. (2011) finds similar characteristics of the excellent fieldwork experience perceived by occupational therapy students that also emerged from this CPAR research data. One of the first characteristics was informative orientation (start) and clear expectations, which reduced the students' anxiety and positively affected their learning flow from the beginning. Organizational challenges were the reason for the frustration and stress shared by students and practitioners while remembering some of their fieldwork experiences.
A quality placement and positive experience were also associated with the opportunity of modeling and learning from educator-practitioners, which naturally supports better learning and development of students' professional skills (Rodger et al., 2011). In our case, such a precedent is harder to achieve, considering educators' and supervisors' current practice field is often not the same as the field they are assigned to supervise students, with the exception of the pediatric field.
Furthermore, the provision of feedback was seen as critical to the quality of the placement. It is another area participants addressed when discussing the program. Students felt a lack of timely and thorough feedback and, in some cases, absent on-site supervisors who can address their practical work and provide the support they need.
Things beyond the supervisor's control also affect the quality of the placement and determine the positive or negative experience for students. The administrative part between school and placement is usually arranged and resolved on an organizational level. In order to make a favorable agreement between two parties, the educational organization needs to advocate and support their students' skill development (Thomas et al., 2007). In our example, this responsibility falls on supervisors and, if not addressed, on students themselves, which naturally is a considerable stressor for students and negatively affects their learning process.
Belonging to a supportive community
Belonging in occupational therapy and science literature is recently added as the fourth dimension of occupation after doing, being, and becoming (Wilcock, 2007). Some argue that besides being another dimension, belonging should be studied and understood in relation to the meaning people attribute to their occupations (Hammell, 2014). Especially in cultures such as Georgian, where connectedness and value of being part of the group are higher compared to some other western cultures. All students mention being part of the occupational therapy community in Georgia as a unique and positive characteristic of the program.
Interestingly, out of the four mentioned dimensions, belonging was distinctly highlighted by most participants. It shows the value it holds and the meaning it has for the students in the process of becoming professionals.
Hammell (2014, p. 41) describes belonging as "social interaction and connections, mutual support and reciprocity, a sense of being valued and socially included, and the ability and opportunity to contribute to others."
The word "support" was often mentioned in connection to the community in narratives of students' photovoice, which once again underlines the role of belonging and the benefits it adds to the experience of being a student and makes the occupation of studying more meaningful.
The type of support students mention is actively sharing information in the OT community. Knowledge and experience in the group are considered a collective resource. In order to foster sharing of this resource within a group or community, interdependency is an essential element (Hammell, 2014).
Once again, it is an example of how belonging is an inseparable dimension of the occupation. Students (being) cannot study (doing) the profession (becoming) in isolation without the support of the community (belonging).
Future professional occupational therapists' first-hand experience of and knowledge about the importance of belonging to the group or community is another aspect worth discussing. During the photovoice participant-led analysis meeting, students had an opportunity to share and critically reflect on the meaning of belonging in the group. It can be helpful for future health professionals, who are expected to address the dimension of belonging with their potential clients, raising critical awareness of their own experience and the benefits of being part of the community (Hammell, 2014). This is mainly because the feeling of belonging is considered one of the components of well-being that affects the quality of life of a person (Hammell & Iwama, 2012).
In this case, a feeling of belongingness can also provide motivation to engage (Baumeister & Leary, 1995) in educational activities. Fostering and using the already existing feeling of belongingness can be a tool to motivate students to be involved in areas that may be less developed or require more attention and support in the program or curricula.
The participatory nature of the process, especially the high interest of students, practitioners, and educators, was perceived as their empowerment. It is a valuable outcome because each member of the professional education community knows their learning needs and problems, so they are in the best position to advise and inform the program (Groundwater-Smith & Mockler, 2016). Additionally, for sustainability reasons, study showed the importance of working across generations between students, practitioners, and teachers. Action research authors call this process the intergenerational transfer of knowledge (Hacker et al., 2012).
CPAR, in particular, offers a powerful stance toward the democratization of knowledge by disrupting traditional hierarchies between researchers and participants, recognizing the expertise of all involved. In post-Soviet and other emerging contexts, where rebuilding trust, autonomy, and local voice in professional education is part of a broader social transformation, this orientation is especially significant. Participatory research, then, can serve not only as a method of inquiry but also as a framework for collective growth and contextual evolution of occupational therapy education. Through CPAR, the process of doing research becomes inseparable from building a more equitable and locally grounded future for the profession.
To continue evolving in this direction, future research should explore the lived experiences of occupational therapy service receivers within Georgia. Including their voices as informants and co-creators in program development could bring new perspectives on relevance, access, and social inclusion helping to align the curriculum more closely with community realities. In this way, CPAR can continue shaping not only what we know, but also how we grow as a profession rooted in context, equity, and collaboration.
Reflections on the research process
CPAR showed that collaboration between current and former students and educators could be the reflective process that leads to a fruitful discussion on important and relevant topics for all parties involved. The process led to creating a shared knowledge that can be a steppingstone toward future problem-solving actions. Following the research cycles enabled co-researchers and educators, together with the involvement of former and existing students, to explore existing barriers in the program. As anticipated, because the design of this study is inherently emergent and transformative (Lake & Wendland, 2018), the process did not follow a prescribed path. However, it unfolded as co-researchers, and other informants shared information and analyzed.
Implications
Generalization of CPAR study findings is not expected, considering the idea and characteristics of the design. It emphasizes local context and is regarded as a “messy” and fluid design and is characterized by constantly emerging positions, ideas, and directions. It is the action at a particular time and location which will and should be different in a different instance (Cockburn & Trentham, 2002). Nevertheless, the research process is a reasonable implication for other education programs to look inwards and consider more actively involving students in the process of developing their program. Creating a common space to share experiences and possible solutions to the issues affecting different members is fruitful instead of isolating those ideas. Such an approach ultimately influences the program’s quality, attitudes, and overall feeling of belonging to the learning community.
The implications identified for occupational therapy education in Georgia have far-reaching significance globally. Firstly, the emphasis on aligning goals with social transformation and community inclusion resonates universally, contributing to a global shift towards holistic healthcare. Secondly, the call for a balance between individual and community needs is pertinent worldwide, reflecting a growing recognition of their interconnectedness. Lastly, equipping graduates with leadership and entrepreneurship skills aligns with a global trend, preparing professionals to navigate evolving health promotion strategies. These insights from Georgia offer valuable contributions to the international community, shaping discussions on enhancing the effectiveness of occupational therapy education and practice globally.
Conclusion
This study explored how the current occupational therapy education program in Georgia prepares professionals to meet local community needs. The findings highlighted the value of context-specific training, the strong influence of pediatric fieldwork experiences on future career choices, the importance of localizing theory, and the role of supportive learning communities. These insights reflect the lived realities of educators, students, and graduates and affirm the potential of participatory approaches like CPAR in fostering reflective dialogue and actionable change within academic programs. The study's outcomes emphasize that responsive, socially grounded, and community-connected education is essential for preparing occupational therapists who can navigate and shape local practice. In this sense, the continued collaborative efforts of the Georgian OT community are not only a testament to the program’s resilience but also an invitation to reimagine occupational therapy education as a co-created, contextually embedded, and transformative process.
Appendix A Action plan.
Findings of the CPAR inspired co-researchers to continue collaborative work outside of the research scope and address emerged topics. Based on the main themes presented in the results, three distinct actions are in implementation plans:
⮚ Already existing students' feedback from earlier years will be appraised and updated, and teachers will begin using it at the end of the spring semester of 2022.
⮚ Teachers decided to arrange an annual OT teacher meeting by the end of each course year, which will be organized. The session will include reviewing student feedback mentioned earlier. And reflect on the program's content and the organizational part, which all study participants often mentioned. It was decided that student representatives will also attend the meetings to have a more inclusive group and make decisions that will be discussed not only between teachers but also among other learning community members.
⮚ It was decided to launch a pilot student assistant program. Considering the constrained time of teachers in academia and a limited number of lecturers and supervisors, each lecturer should have 3rd and 4th-year students who can assist in organizing the teaching process to become more proactive.
Appendix B Interview guide.
Background
⮚ What is your degree?
⮚ What is your experience? (Years of practice, the field of practice)
⮚ What determined your choice of fieldwork/practice?
About the program
⮚ What do you think about the education program’s relevance to the local socio-political background? Why?
⮚ In your opinion, did the theory learned during your studies give you enough knowledge and skills to become the professional you are now? Give me examples, please.
⮚ In your opinion, the practical assignments and supervision during your studies gave you enough knowledge and skills to become the professional you are now. Give me examples, please
⮚ What would it be a thing or more that you would want to change in the program? Why?
Questions for photovoice
⮚ What are some attributes of the program that helps you learn/ supports you in your learning process (strengths of the program)?
⮚ What are some attributes of the program that makes it challenging for you to learn (weaknesses of the program)?
⮚ What are some at`tributes of the education program that makes it unique and different for you?
Appendix C Photovoice data code mapping: iterations of analysis (to be read from the bottom up).
| Third Iteration: Themes | ||
|---|---|---|
| 1. Learning by doing – ready for the real world | 2. making learning attainable | 3. belonging to the supportive community |
| Second Iteration: Categories | ||
| 1. Learning by doing – ready for the real world | 2a. making sense of existing literature | 3. part of supportive community |
| 2b. organizational stressors | ||
| First Iteration: Codes | ||
| 1. equipped for the future | 2a. misunderstanding terminology | 3. Sense of belonging to learning community |
| 1. Gaining Nonacademic skills | 2a. only English literature | 3. Supportive community of academics and non-academics |
| 1. Diverse learning strategies | 2a. Absence of Georgian examples | |
| 1. learning by doing – practice based | 2b. stress caused by unpredictable deadlines | |
| 2b. frustration with late or missed classes |
Interview data code mapping: iterations of analysis (to be read from the bottom up)
| Third Iteration: Themes | ||
|---|---|---|
| 1. Lack of accessible and applicable literature | 2. preparing pediatric OT practitioners | 3. support on and off the field |
| Second Iteration: Categories | ||
| 1. Lack of accessible and applicable literature | 2a. Pediatric field dominance in the program | 3a. reality of being alone in the field |
| 2b. favored practical/fieldwork part of the program | 3b. plan and support – teachers for the rescue | |
| First Iteration: Codes | ||
| 1. hard to translate – terminology and everything else | 2a. supported supervision in pediatric practice | 3a. self-supplied fieldwork cases by students |
| 1. theory’s irrelevance to local practice context | 2a. gives applied techniques in pediatrics | 3a. In need of more field based supported supervision |
| 2b. program’s focus on practical part | 3b. organizational challenges: planning the module from start to end | |
| 2b. practice – what makes me professional | 3b. In need of more support from teachers in learning process |
Acknowledgements
This publication is based on the thesis research of the first author, conducted within the European Master of Science in Occupational Therapy.
With thanks to all educators in the program for their guidance and mentorship throughout the research journey, particluarly to my thesis-supervisors, now co-authors.
Sincere gratitude to all those who contributed to the completion of this research, particularly the local core research team and participants in Georgia, without whom this study would have been imipossible.
My deepest gratitude go to Hanneke van Bruggen and Nino Rukadze, who founded and shaped the profession of occupational therapy in Georgia and have both been consistent personal mentors to me throughout my professional journey, including this research.
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How to cite:
Revazishvili, A., Kramer-Roy, D., & Rivas-Quarneti, N. (2025). Relevance of an undergraduate occupational therapy education program: a critical participatory action research study. Cadernos Brasileiros de Terapia Ocupacional, 33, e4019. https://doi.org/10.1590/2526-8910.ctoAO410340192
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World Health Organization – WHO. (2021). Constitution Retrieved in 2024, December 21, from https://www.who.int/about/governance/constitution
» https://www.who.int/about/governance/constitution
Edited by
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Section editor
Profa. Dra. Ana Paula Serrata Malfitano
Publication Dates
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Publication in this collection
11 July 2025 -
Date of issue
2025
History
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Received
21 Dec 2024 -
Reviewed
30 Jan 2025 -
Accepted
30 Apr 2025
